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Concern that living near a particular landfill site in Wales caused increased risk of births with congenital malformations led us to examine whether residents living close to 24 landfill sites in Wales experienced increased rates of congenital anomalies after the landfills opened compared with before they opened. We carried out a small-area study in which expected rates of congenital anomalies in births to mothers living within 2 km of the sites, before and after opening of the sites, were estimated from a logistic regression model fitted to all births in residents living at least 4 km away from these sites and hence not likely to be subject to contamination from a landfill, adjusting for hospital catchment area, year of birth, sex, maternal age, and socioeconomic deprivation score. We investigated all births from 1983 through 1997 with at least one recorded congenital anomaly [International Classification of Diseases, Ninth Revision (ICD-9), codes 7400-7599; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), codes Q000-Q999]. The ratio of the observed to expected rates of congenital anomalies before landfills opened was 0.87 [95% confidence interval (CI), 0.75-1.00], and this increased to 1.21 (95% CI, 1.04-1.40) after opening, giving a standardized risk ratio of 1.39 (95% CI, 1.12-1.72). Enhanced congenital malformation surveillance data collected from 1998 through 2000 showed a standardized risk ratio of 1.04 (95% CI, 0.88-1.21). Causal inferences are difficult because of possible biases from incomplete case ascertainment, lack of data on individual-level exposures, and other socioeconomic and lifestyle factors that may confound a relationship with area of residence. However, the increase in risk after the sites opened requires continued enhanced surveillance of congenital anomalies, and site-specific chemical exposure studies. Key words: congenital malformations, epidemiology, landfill, small-area health statistics.

Risk of Congenital Anomalies after the Opening of Landfill Sites